Monday, August 30, 2010

I am married. You may not have noticed my ring. Or my kid's drawings all over the place. Or the brief phone call I had with Mrs. Grumpy in front of you to work out who's picking up the tribe tonight.

Batting your eyelashes, adjusting yourself in your chair so that all of us could see you're wearing a thong, talking about how lonely you are being new in this town, and giving me a card with your home phone on it "just in case you have questions about the drug, or anything else" does NOT score you points in my office.

Try the plastic surgeon downstairs. His trophy wife (3rd wife, 28 years younger then he is) just turned 35, so he's likely looking for a newer model.

Saturday, August 28, 2010

One of the most hated parts of residency is having to call an attending at night about a new admission. In most programs this is required, and you don't have a choice. It consists of dialing up the senior doc on call, running a case by them quickly, and making sure they agree with what you're doing.

Generally you try and make it quick. You're busy. They're trying to sleep.

There was one doctor in my program, Dr. Flat, who was notorious for his rapid monotone. He spoke at warp speed, but his voice never changed, and he never strayed from business. If he had a sense of humor, none of us ever saw it.

One weeknight I was on call, and was admitting a stroke patient. It was about 10:00 p.m, and I made the obligatory call to Dr. Flat.

Dr. Grumpy: "So I'm admitting him to the telemetry floor, and started him on Aspirin. I've ordered an MRI, and..."

Dr. Flat: Mmmmm. YAWNNNNNN

Dr. Grumpy: "I'm sorry, sir. Did I wake you up?"

Dr. Flat:"No, my wife and I just finished having sex. What's his blood pressure?"

Dr. Grumpy: "Okay, we're done with the EMG. I'm going across the hall to my office. Why don't you toss the paper gown in the trash, put your shirt back on, and meet me over there to discuss the results."

Mrs. Hedinbutt: "It's not a shirt. It's a blouse."

Dr. Grumpy: "Okay. Anyway, after you have it on, come over and..."

Mrs. Hedinbutt: "Don't you even know the difference?"

Dr. Grumpy: "Well a..."

Mrs. Hedinbutt: "For crying out loud! You're a doctor and you can't even tell a blouse from a shirt! How did you get through medical school!"

(long pause)

Dr. Grumpy: "Look. Do you want to go over the EMG results or not?"

Mrs. Hedinbutt: "I don't have time for this. Just send them to Dr. Imed and I'll discuss it with him." (puts on blouse/shirt/vest/tunic/upper body garment/whatever and leaves).

Thursday, August 26, 2010

Your appointment is over. You are certainly welcome to wait in my lobby for your ride, to complete paperwork, or to have some water to recover from your grueling appointment with me.

However, please DO NOT USE my lobby for any of the following activities:

To use a phone (mine or yours) to make political calls on behalf of whatever candidate you're supporting this year. I respect your right to be involved in politics, but my waiting room isn't the place to do it. Not everyone out there agrees with you.

To have the sandwich, pickle, and bag of chips you've been carrying around in your purse. I don't mind you grabbing lunch in a hurry, but spending an hour here eating, calling friends, and using my magazines as napkins is a bit much (If this sounds familiar to you, asking Mary if we had any salt and a can of Sprite was over the line).

To call several local restaurants to set up catering for a party.

To try and sell real estate opportunities to other patients who are waiting to see me.

To see how much more (or less) your specialist co-pay is compared to other patients.

To hand out flyers to see your band play at Bubba's Roadhouse this weekend.

To argue about ANYTHING featured in "People" magazine.

To wait and see if a drug rep with samples of your medicine wanders in, and then assault them.

To ask my other patients what they think of your stock-market investment picks.

To appoint yourself schedule monitor, and tell Mary who signed in before whom.

To get out a scissor and cut coupons, articles, pictures, and anything else that strikes your fancy out of my lobby magazines.

"Hi, Dr. Grumpy. My husband sees you for Parkinson's disease. Anyway, I'm in Calorie Counters, and we have a meeting tonight in the church down the road from your office, and our scale is broken, and I know you and Dr. Pissy have one in your hallway there, and I was wondering if you could meet us at your office and let us in to use your scale for a few minutes."

Monday, August 23, 2010

"My headaches and stuff are about the same. I didn't start that medication stuff you prescribed last time, because I wanted to try massage and exercise stuff to see if the head stuff got any better. But the headache type stuff is worse, cuz my husband and kids and stress and stuff have had all kinds of stuff going on, so I wanted to talk about more stuff with you, like the pills and stuff, because my head stuff is getting out of control."

Dr. Pissy and I have shared an office for 11 years. We joke, bitch, whine, and try to make the most of our bizarre days as we work through the schedule. Day in and day out. 11 years now.

And guess what? We're on opposite sides of the political fence.

And we discuss health care, and politics, and war, and peace, and all kinds of other stuff. And we've never had an unfriendly moment doing it. Sometimes we come up with ideas that might actually work, and be an acceptable compromise. Sometimes we don't.

I'm not saying we should be in charge of anything. I mean, hell, what do we know? Maybe our ideas wouldn't work.

What I want to know is why politicians end up as the jerk-offs they often are. They must start out like us, at some point. On both sides of the aisle. Willing to talk and work things out. I mean, most of them are married, so should be used to the negotiations and compromise of REALLY complex human relationships.

So why is it that, as soon as someone actually gets elected, they revert to a preschool level of immaturity? Instead of trying to work things out, all they can do is scream, pout, and point fingers at the other children (who do the same back at them).

Every government in history has been founded on the idea of compromise. Every marriage, friendship, business, and child-raising depends on it to work out differences. So where the hell did it go in the modern government?

Is this kind of idiocy and inability to work together really something that anyone sees as being good? People refuse to work together, and then run for re-election on that idea- that they acted like a child (except I think politicians like to call it "standing up for my principles").

I suspect part of the problem is vitriolic idiots from both sides on cable news, who aren't running for office (and therefore have nothing to lose), spewing idealistic shit that may sound good to their audiences, but in reality won't work. And any politician who actually tries to work out a problem reasonably gets chewed out by these clowns as being weak and worthless.

I think all these political types need to go back to the sandbox, and re-learn basic playground etiquette: Be polite, wait your turn, share, make friends, treat others as you'd like to be treated, and WORK IT OUT.

Most governments were founded on the idea of negotiation and compromise. So why is it considered better now to just scream, pout, and do absolutely nothing? Or (my pet peeve) putting pissy little issues at the forefront to distract attention from the fact that they aren't trying to actually solve anything. It's easy to scream, but a lot harder to actually work out a solution. I don't think any of us are paying you guys to be petulant crybabies.

As you guys know, the Grumpy family likes cruise vacations. The crews on these ships are a remarkable polyglot of races, nationalities, and cultures. And they work very well together, BECAUSE THEY HAVE TO. If not, the passengers are unhappy, or the ship breaks, and they all get fired (at the minimum). So why the hell can't our elected representatives (who get paid A LOT more)?

Screaming and yelling may get you favor with whatever local groups whose ass you're kissing, but isn't in the best interests of any group as a whole. No matter what country you live in, or what side you're on.

Last night was "Meet the 4th grade teachers night" at the twins' school. For most families only one parents needs to go, but when you have 2 kids in the same grade, you both go and take notes.

This is never fun. Because it's pretty damn hot in the building. School ends at 3:00, and the district, to save money, turns off the air conditioning at 3:15. In the middle of freakin' Summer. So by 5:00 the classrooms are sweltering.

The teachers aren't too fond of this either, because they have to stay late in the hot room, and deal with that most dreaded creature of all, the crazed parent. I show up with nothing but my clothes and cell phone (which I silence) and most parents do the same.

But there are a terrifying minority who show up with detailed print-outs of their kids capabilities, restrictions, non-allergic and non-religious dietary requirements ("Suzy likes PBJ and chips, so I pack those. Make sure she eats 1/2 sandwich, THEN the chips, then the other sandwich half. Any other order is bad for brain growth. I read that in a magazine once"- Yes folks, I really did hear a parent say that last year).

So we file in. The room is hot. Many parents are pouring sweat, having just come from work in bulky business clothes. Then we have to find OUR kid's desk, and cram our big fat overweight adult butts into seats designed for a 9 year old.

So now, in addition to being hot, we were all miserably uncomfortable and complaining about back pain. Seeing an opportunity, I handed out some business cards.

As if it wasn't hot enough already, the door opened and Craig's teacher, Miss Reba walked in. And the room went from hot, to hot and steamy.

She was sizzling. Suddenly all the Dads who'd been bitching about having to go to this were quiet. Now they were pissed off their kid didn't have a desk closer to the front of the room.

Miss Reba, as seen by the male parents.

And then the fun began.

Miss Reba had organized a detailed Powerpoint presentation, which was shown on some sort of interactive board at the front of the room (I guess blackboards and chalk have finally gone the way of the dinosaur). To advance slides, she had to tap on the board. Unfortunately, the board didn't grasp this concept very well, and so her taps had a 25% chance of advancing to the next slide, 25% chance of going to the previous slide, and a 50% chance of doing nothing. When the last happened, she'd pound on it repeatedly, getting louder each time, until we were afraid the board would crack or fall down.

Come to think of it, I think many of us were hoping it would fall, and knock her out. Some would get to leave early, and the rest would fight over who got to resuscitate her. As a doctor sitting in the front row, I figured I had a good shot.

She was a fast talker, but had only 1 hour to cover the entire school year. As a result, she leaped from topic to topic, ending each slide's summary by saying "And I update my website daily, so you can see what the kids are doing. Please check it regularly."

As usual, parents asked some remarkably stupid questions:

"You said the kids wouldn't have homework over the weekends. What about Fridays? Will you be sending stuff home for them to do on Friday nights?"

"If I send lunch with my kids, can you tell them what the nutritional value is? I think it's important that they know these things."

"Do you watch iCarly?"

"Do we need to check your website? Or can I just make my kid do it?"

And my personal favorite:

Miss Reba: "In music next month, the kids will learn about strings. Check my website for the dates."

Miss Reba: "No. I said it's a music class. As in string instruments. Like a violin."

At this point, Miss Reba uttered the most dreaded words in the history of parent-teacher relationships: ""Now, I'll need some parents to volunteer..." Suddenly all of the hormonally charged fathers were checking their cell phones. Mothers suddenly had urgent texts to send. Nobody, not even the single fathers, made eye contact with Miss Reba as she ran down the list of class party organizers, reading assistants, paper copiers, and other volunteers that were needed. Usually there's some hyperactive-mother-on-speed who immediately leaps out of her chair and signs up for all of this, but she wasn't here tonight. I began picking at my face and loudly mentioned that my Leprosy treatments kept me from working with kids.

After getting home, Mrs. Grumpy and I compared notes, and now she wants to kill me.

As a public service, I'm re-running this from last August for those of you who missed it the first time around. It's certainly relevant.

Dr. Grumpy's Guide to Life, Chapter 2: Shopping for school supplies

Okay, so this is the 2nd edition of my helpful newsletter (If you missed the 1st one on surviving your child's birthday party, click here).

Today's issue will focus on what I discovered to be a horribly traumatic life-altering experience: Back-to-School week at OfficeStaplesMaxDepot. There's one right across the street from my office, so I go there regularly for supplies. It's quiet, the employees are generally helpful, and I know my way around it pretty well.

I naively thought this would be easy.

So on to the lesson:

1. Do NOT volunteer for this job (flip a coin, or arm wrestle, or have a duel to decide instead).

Silly me. When Mrs. Grumpy was wondering when she'd have time to get the school supplies, I volunteered. I figured "How hard can it be? Hell, it's just some pencils and a bottle of glue". DUMBASS!!! The list is HUGE, and features items from the mundane (No. 2 pencils), to the specific (Expo dry erase markers, wide tip, in blue, green, yellow, and black) to the odd (1 Pringles can with lid, original flavor, empty). It took me 2 freakin' hours!

2. Be prepared. Normally there are 5-10 other quiet business-type people in there. NOT THIS WEEK! Holy Crap! An African street bazaar is an orderly affair compared to this! Deranged parents running on caffeine! Kids running amuck! Store clerks running for their lives! And all the crazed parents are trying to read off a list, push a cart, yell at kids, text, and scream into a cell phone at the same time. Bring a water bottle, food, a map, a cattle prod, and a flashlight. A card with your blood type, hospital preference, and next of kin is also a good idea.

3. Do not leave your cart unattended. People will steal your shit out of it. I AM NOT MAKING THIS UP! I had my cart 2/3 full with the crap on my list, when I left it at the end of an aisle to go find notebooks (spiral, wide-ruled, 100 pages each, single subject, 1 red, 1 blue, 1 green). When I returned 3 minutes later about half the stuff I'd already put in it was GONE! I watched a few minutes later as it happened to others. Apparently, when you walk away from your cart, people think it means they can raid it for supplies they haven't had a chance to pick up yet. "Hey, this guy has those index cards (2 sizes, lined and unlined, 100 each) that my kid needs. Cool. I'll scratch that off my list".

If another parent asks you what school your kid goes to, or who their teacher is, DO NOT ANSWER. Ignore them. Pretend you're deaf, or that you don't speak English. They are not making conversation. They are casing your cart, and if they find out your kid is in the same class as their kid, they'll wait until you aren't looking to take your stuff (or just switch carts).

Best part was when I went to ask an employee for help finding something (Flair Correction Pens, in 4 colors). When I got back to my cart the box of 12 ultra-fine tip Sharpies I left in it had been opened, and someone had taken one of them. They'd even doodled on the shopping list I left in my cart to make sure they were taking a pen that worked.

Oddly, you can leave valuables in your cart. Your wallet, purse, and gold jewelry will be perfectly safe if left unattended, but the $2.69 box of high-lighters (12 markers, large tip, in 3 colors) will vanish.

My recommendation: bring a child to guard your cart, preferably one with an iron bladder and who's old enough to use a Taser or firearm if needed. If your kids don't meet this requirement, stop by Home Depot and hire one of the day laborers who hangs out in front looking for work.

4. Do not look for certain numbers of things. The people who make these lists have no idea how things are sold, so it lists things as "1 Expo dry erase marker, chisel-tip, red). Great. They don't sell red ones individually, just in boxes of 4. Or the Flair Correction Pens don't come in only 4 colors, but they do come in 8. Just buy it. If you aren't certain what item the teacher wants, just buy everything in sight and return the rejects later.

Alternatively, if the teacher only wants 1 of an item, such as, say, an ultra-fine tip Sharpie (which only come in boxes of 12), you can always look for an unattended cart with a box of them in it, and take one. If paper is handy, try doodling on it to make sure you are stealing one that works.

5. Hold your place in the check-out line AT ALL COSTS. Reserve it as soon as you walk in the store BEFORE shopping. Use a child (preferably your own) if possible. Other options include day laborers from Home Depot, mannequins, dogs, and aggressive Venus Fly Traps.

6. When in doubt, ask the bleary-eyed, terrified employees for help. If nothing else, it's fun to watch them try to convince you that they don't speak English as they run outside for a cigarette.

Now, I know bariatric surgery is somewhat controversial. Like all docs, I've seen my share of patients who didn't benefit from it, or had serious complications. But this post isn't a forum for that.

Let's look at this practically. If a person has bariatric surgery, they should be more likely to lose wieght, and have fewer long-term complications of obesity, then someone who doesn't have the surgery. Right?

Of course, somebody felt the need to study this. I assume this was done to be able to improve insurance coverage of the procedure.

I found this AWESOME back-to-school advice on The Mother's site. And she should know. She's a mother with 4 boys- and she's also a doctor. In other words, don't mess with her.

The Mother's 12 Step, Back-to-School Program.

Step #1: Refill the kid’s lunch money account online at least a week ahead. That way, you can shove the little angels out the door without hunting down spare change or playing lunchbox roulette.

#2: Prepare the child’s necessary school supplies three weeks in advance. Nowadays most schools have packet lists on the internet, and a whole lot of grocery stores sell them in those packets. Buy them prepackaged. It’s worth the extra buck, because the guys who do the prepackaging have bought out all the orange folders in town, and the English teacher only wants orange folders, and you do NOT want to have to go to the next county to get a damn orange folder. Don’t wait, though, or the little packets will be extinct.

#3: High school kids NEVER get a list in advance. They get a list from each teacher on the first day, prompting the Mad, Mad, Mad World remake at the local office supply store. YOU DO NOT WANT TO BE A PART OF THIS. Go ahead of time. Buy a $100 gift card. Give it to high schooler. Have him call you for a ride when he’s done. There’s always a Starbucks nearby.

#4: Make friends with the Amazon team. Kids always come home with a list of the books they’ll need to get for the year. They never remember to give it to you. You will then be regaled five times a year with a “last minute request.” The book will be sold out in every bookstore in the tri-county area. Steal the list from the child’s backpack on the way in the door. Go directly to Amazon. Do NOT pass go. Type in each book, and click “buy it now.” Then, when they arrive in two days , HIDE THEM until they are needed– trust me on this one.

#5: Plan take out for the first night. Stock up on advil, and buy one of those hand splints in advance, because the cramping from filling out the forms will leave you in agony for days. If you have more than one child going to the same school, get one of your kids to rig up a scanner. Or borrow a photocopier. Extra points if you are ambidextrous. Extra, extra bonus points if you make your high schooler fill them out himself and just sign. Post all emergency numbers on the white board in the kitchen and hand them all sharpies.

#6: Make sure you have money in your checkbook. It’s someone’s conspiracy that schools generally start at the end of the month, when everyone is low on funds. Then the four thousand little checks that have to be written add up–$10 for a directory, $5 for a lab manual, $15 for the debate briefs, $6 for the PTA lunch fund, … Double check your check stock, too.

#7: Do not, under any circumstances, accompany a child older than 12 into the school. They have to learn to fend for themselves sometime–Junior High seems like a good spot. Younger, if you think you can get away with it.

#8: If you do walk in with your child, leave as soon as said kid gets interested in something else. Ask any teacher–parents who hang around cause problems. Unless this is your little tyke’s first day of kindergarten, beetle out.

#10: Do not allow inter-child comparison of teachers. As a mom of four, I now have three who have had many of the same teachers. They have three different takes. Squash it, fast, before poor Ms. Jones, the English teacher, gets maligned by the kid with superior math skills and NO ability to parse prose.

#11: Take advantage of the state-tax-free weekend. Take each kid out (separately). See what fits. Put that size back and buy the next size up.

#12: When the teacher asks for volunteers, RUN, do not walk, to the nearest exit. Bonus points for getting there first. (Of course, if you hadn’t gone IN, you wouldn’t be in this position).

This picture was featured in a mailing I received. It's for a DVD program on Parkinson's disease. It is, I swear, a video of 4 neurologists arguing. Yeah, like I'm just dying to watch that.

(click to enlarge)

The distinguished faculty in the picture are named as (left to right) Drs. Sethi, Obeso, Olanow, and Stern.

Believe it or not, this is about as exciting as a party of neurologists gets. They sit around and discuss Parkinson's disease and other invigorating topics. And people wonder why I'm in solo practice.

I'm not convinced that's water in their glasses, either. Vodka, maybe.

Obviously, the star of the picture is Dr. Olanow. He looks like he's one step away from wearing a lampshade on his head. I'd like to think he's talking about his windsurfing trip over the summer, and how he accidentally ended up starring in an Absolut vodka commercial with the Sports Illustrated swimsuit models. More likely, though, he really is talking about Parkinson's disease. Only a neurologist can look so happy while talking about something that would scare everyone else away.

Let's try to guess what they're thinking:

Dr. Sethi: "Wow. Olanow has had too many already. He always gets the spotlight, and the hot drug reps. And what the hell did he do with my tie? As soon as I walked in he asked to borrow my tie because he forgot his, and now he isn't even wearing it. I have to remember to get the phone number for that Absolut girl who keeps refilling our glasses. I hope she saw that I drive a Porsche."

Dr. Obeso: "I have noooooo idea what they put in the vodka. I've only had 2 so far. I'm not touching it again. Holy crap, I hope I don't puke at the table. Olanow would never let me live that down. He'd probably show slides of it at next year's academy meetings. How come I'm the only one here who's wearing a tie?"

Dr. Olanow: "Man! Thish party is great! I better hit up Stern for cab fair back to the hotel, because I spent the travel stipend on the keg party last night. I hope nobody notices the tie I took from Sethi is missing. I gave it to that hot drug rep after writing my hotel room on it with her lipstick."

Dr. Stern: "I have to pee, and Olanow won't STFU. Maybe if I cross my legs. I didn't even see a bathroom when we came in. Maybe there isn't one. What do I do then? What the hell is he even talking about, anyway? Why does he need $20? He still hasn't paid me back from the last meeting. At least I have a good chance of getting laid tonight, because that sizzling drug rep gave me a tie with a room number written on it in lipstick."

A key epilepsy question (at least to a neurologist) is "Where in the brain is the seizure coming from?"

As a result of this, we neuro docs look for clues as to which side of the brain is the seizure trigger, so to speak (we call it "lateralization"). Sometimes the answer is obvious on MRI or EEG, sometimes it's more subtle. In those cases we have to look for details in the patient's history or exam that lead us to the answer. Different findings have what we call "lateralizing value", meaning how useful it is.

Now, I'm all for further research into this. But, I have to say, some researchers looking for new lateralizing features have gone a bit too far. Or at least shown a determination to notice things that I don't want to.

(Neurology word: "Ictal" means "seizure-related")

Click to enlarge

I'd like to thank the Science Marches On Department for bringing this important research to my attention.

Saturday, August 7, 2010

It was the early 80's, and Big State University was under a reign of terror (okay, more of a reign of creepiness) about an evil criminal mastermind.

I don't remember his name, if I ever knew it at all. One of my co-workers dubbed him "The Mad Whacker". It was as good a title as any.

He had a fetish for buildings. Really. He was sighted in front of various places on and around campus, staring at buildings, and, uh, madly whacking.

But he had a preference for religious places. The Mormon center. The Campus Crusade for Christ office. The Jewish Hillel center. He didn't discriminate. He'd stand in front of them at night, and, if he didn't see anyone immediately around him, do his thing.

Enter into the picture young BSU student Ibee Grumpy.

He was thinking about becoming a doctor someday, so was looking for anything to pad his resumé. More importantly, he was interested in meeting girls. Or at least trying to figure out how to talk to one without barfing from anxiety.

So he joined the campus safety patrol. This group of dedicated (and similarly lonely, resumé padding geeks) carried radios and were tasked with walking girls to different locations around campus at night to help deter crime.

So one night, Student Grumpy was on his way back from walking a girl out to her car, and took a shortcut near the Catholic center.

And there he was.

I don't remember who was working dispatch that night. I think it was a guy named Rob. I picked up my radio, trying not to be too loud.

"Come in, Rob"

(for those of you who remember the scene in Ghostbusters, I felt like Bill Murray, mumbling into the radio "Come in, Ray. It's looking right at me, Ray." And like Bill Murray's character, I was hoping not to get slimed).

Friday, August 6, 2010

Ms. Daughter: "Hi, my Dad has Parkinson's disease, and I was wondering if you had any birthday gift ideas specifically for Parkinson's patients?"

Annie: "Hmm. Well, there's a really good physical therapy program for them over at Local Rehab."

Ms. Daughter: "No, I'd have to drive him to that, and don't have the time. He already has a cane, otherwise I'd get him one. Can you write a script under my name for his meds? That way I can have my insurance pay for them, and save him money?"

Annie: "No, we really can't do that. What about just a regular gift? Like baseball tickets, or a book?"

Ms. Daughter: "No... He likes movies. Do you know of any movies that are out now about Parkinson's disease? He's already seen 'Awakenings'."

My copy is 118 pages, of regular size print. You can read it in an afternoon.

It's just a story about 6 people, all ordinary people, and strangers to each other.

It's just a collection of interviews, first published by "The New Yorker" magazine in 1946, and later put together as a book.

It's never, to my knowledge, gone entirely out of print. You can buy it, used and new, on Amazon for a few bucks (no, I'm not selling my copy. It's a 1946 original, and I stumbled across it in 1996 for $12.85 at a used book store).

It's called, simply, "Hiroshima", and it was written by John Hersey.

It has no science in it. No history of the development of the bomb. No history of World War II (aside from the immediate content). No political commentary on the right or wrong of war. Minimal, if any, emotion. If anything, it's rather dry and simply factual about what the people interviewed said.

It's the collected experiences of 6 people, who at 8:15 a.m. were all 1/2 to 2 miles from the center of the Hiroshima nuclear bomb explosion, and their experiences in the minutes to a few days after.

Thursday, August 5, 2010

"Impression: Patient referred here for carpal tunnel syndrome. She clearly has significant headaches, though denies having headaches at all. She also obviously has trouble sleeping, though tells me she sleeps fine. She keeps asking me to address her carpal tunnel syndrome, but that's not the main issue here."

Wednesday, August 4, 2010

Dave showed up at my office last week with neck pain, worsening weakness in his arms and legs, and changes in his bladder control. All signs pointed to something gone bad in his neck.

His internist had already thought of this, because he'd ordered the appropriate MRI's. And they'd all been read as normal, leaving me without a cause.

Here is where the problem began. EVERYTHING about Dave's exam and story pointed to something serious in his neck. But the tests were normal...

There are A LOT of MRI places out there. Some of them have good quality machines, while others haven't updated their machines, or software, in a long time. In addition to this, some places use specially trained neuro-radiologists to read MRI's, while others use general radiologists. So there's a different quality of reader, too.

This isn't meant as a slap against general radiologists. As a general neurologist, I don't claim to be exceptionally good at various subdivisions of my field, either. No one is good at everything, and recognizing our limitations is part of the job.

As a result, Annie and I have a short list of MRI places I use, where I trust both the equipment and radiologists.

But your average internist doesn't usually know the difference, as they're too busy with the insanity of a general medical practice. Most of the time the decision is made by a scheduling person, based on the patient's insurance, when the next available opening is, and maybe even what place brought them lunch. And, Dave, unfortunately, had his studies done at Shitty MRI, Inc.

So I called Shitty MRI, Inc., and asked for the films, which came the next day. The image quality was terrible, and Dave moved during the study. From what I could see, the films were unreadable.

But I'm not much of a radiologist, let alone a neuro-radiologist. So I dragged the films to someone I trust. She agreed. They were unreadable and worthless.

Now, it might have been a tolerable situation if the reading doctor had dictated something about the films being useless, and recommended they be repeated with sedation, or on a different machine, or whatever. But instead he dictated them as normal.

So I needed another MRI, done on a decent machine, with sedation, and read by a neuro-radiologist. Easier said than done.

I ordered the study. His insurance denied it, on the grounds that he just had an MRI last week, and so they wouldn't pay for another.

I appealed it, and personally called their physician-reviewer. I told him the patient had something serious going wrong in his neck. I told him the previous films were worthless. I even offered to send him the films to look at himself.

He told me that I'd have to live with them, and it wasn't his fault that the ordering doctor had chosen that facility.

I admitted Dave to the hospital. It was a gamble. Once I had him in I could do whatever tests I wanted, but if I were wrong, it would be a nightmare to justify the admit to his insurance.

While I was working at my desk, Dave was rolling into the hospital's MRI. Within an hour the neuro-radiologist called me. Dave had a HUGE herniated disk in his neck, crushing his spinal cord. I called a neurosurgeon immediately, and 2 hours later Dave was having the disk, and it's threat of landing him in a wheelchair, taken out.

Dave did fine.

But the case is still pretty damn scary when you think about what might have been.

In my continuing attempts to bring you awesome writing that deserves wide recognition, I'd like to present this comedy piece. It was recently written by my esteemed colleague Phathead. I take no credit for it at all, except to say I laughed quite hard.

It seems as if you can get almost anything in 'HD' today. Oh no, HD is not just for televisions anymore. There are HD Sunglasses, HD paint, and I even saw a sticker on a mirror claiming it was HD quality.

Naturally, it would make sense for Big Pharma to jump in on this. And why not? They prey on the lack of knowledge the public has on drugs, so might as well kick it up a notch.

I'm sure it would go something like this:

NEW YORK CITY, NY - Today Pfizer CEO Jeff Kindler announced their newest product to be offered to consumers, Lipitor-HD."Everyone knows that Lipitor will soon be going off patent. As a company that's been unable to produce an innovative drug in years, it's imperative that we find some way to continue making money while doing as little work as possible", he said.

"One of the most popular terms signifying quality and wealth is the phrase 'High-Definition' or simply 'HD'. We decided that we needed to be the first company to produce a HD drug, and thus Lipitor-HD was born."

Kindler said Pfizer will explain to consumers that Lipitor-HD is Lipitor, but at a much higher resolution. This makes it more effective because a higher resolution automatically means it works better.

"Then we decided to market it in a 10,000 µg, 20,000 µg, 40,000 µg and 80,000 µg (instead of the previous 10mg, 20mg, 40mg, and 80mg) because bigger numbers mean that Lipitor-HD is more powerful than non-HD Lipitor."

It is expected that Pfizer will price Lipitor-HD at a 50% markup from the current price of Lipitor.

"The increase in price is representative of the fact that we'll continue to make sure the public believes our product to be vastly superior to any generic counterpart."

Monday, August 2, 2010

Mr. Druggee: "This is very stressful, and you're not helping me. I'll just have to start smoking again, because of you. And when I die of lung cancer someday it'll all be your fault, and I hope my family comes after you and sues your ass to the poorhouse."

27 job offers, all of them offering a huge salary, incredible benefits, and infrequent call in places with low crime rates, wonderful year-round climates, great activities, and excellent schools. None of them actually tell you where these places are, of course (they want you to call to find out). Perhaps on the banks of the beautiful river Wah-Hoo?

16 ads for medical education conferences on such topics as "The neurological manifestations of toenail fungus" and "Halitosis- Can you bill extra for putting up with it?"

1 letter to join the U.S. Army reserves, saying the army needs doctors with my skills (yet showing a picture of a guy doing surgery, which definitely ain't my skill).

24 ads from drug companies touting the virtues of their now once-a-day drug, which is otherwise identical to their previous twice-a-day drug (now available as a generic, of course) but costs 478% more per pill.

Today I am flying home, while Mrs. Grumpy finishes her family visits. So while I travel, I leave you with one of my favorite poems.

The Cremation of Sam McGee

by Robert Service

There are strange things done in the midnight sun By the men who moil for gold;The Arctic trails have their secret talesThat would make your blood run cold;The Northern Lights have seen queer sights,But the queerest they ever did seeWas that night on the marge of Lake LebargeI cremated Sam McGee.

Now Sam McGee was from Tennessee, where the cotton blooms and blows.Why he left his home in the South to roam 'round the Pole, God only knows.He was always cold, but the land of gold seemed to hold him like a spell;Though he'd often say in his homely way that "he'd sooner live in hell."

On a Christmas Day we were mushing our way over the Dawson trail.Talk of your cold! through the parka's fold it stabbed like a driven nail.If our eyes we'd close, then the lashes froze till sometimes we couldn't see;It wasn't much fun, but the only one to whimper was Sam McGee.

And that very night, as we lay packed tight in our robes beneath the snow,And the dogs were fed, and the stars o'erhead were dancing heel and toe,He turned to me, and "Cap," says he, "I'll cash in this trip, I guess;And if I do, I'm asking that you won't refuse my last request."

Well, he seemed so low that I couldn't say no; then he says with a sort of moan:"It's the cursed cold, and it's got right hold, till I'm chilled clean through to the bone.Yet 'tain't being dead — it's my awful dread of the icy grave that pains;So I want you to swear that, foul or fair, you'll cremate my last remains."

A pal's last need is a thing to heed, so I swore I would not fail;And we started on at the streak of dawn; but God! he looked ghastly pale.He crouched on the sleigh, and he raved all day of his home in Tennessee;And before nightfall a corpse was all that was left of Sam McGee.

There wasn't a breath in that land of death, and I hurried, horror-driven,With a corpse half hid that I couldn't get rid, because of a promise given;It was lashed to the sleigh, and it seemed to say: "You may tax your brawn and brains,But you promised true, and it's up to you, to cremate these last remains."

Now a promise made is a debt unpaid, and the trail has its own stern code.In the days to come, though my lips were dumb, in my heart how I cursed that load.In the long, long night, by the lone firelight, while the huskies, round in a ring,Howled out their woes to the homeless snows — Oh God! how I loathed the thing.

And every day that quiet clay seemed to heavy and heavier grow;And on I went, though the dogs were spent and the grub was getting low;The trail was bad, and I felt half mad, but I swore I would not give in;And I'd often sing to the hateful thing, and it hearkened with a grin.

Till I came to the marge of Lake Lebarge, and a derelict there lay;It was jammed in the ice, but I saw in a trice it was called the "Alice May."And I looked at it, and I thought a bit, and I looked at my frozen chum;Then "Here," said I, with a sudden cry, "is my cre-ma-tor-eum."

Some planks I tore from the cabin floor, and I lit the boiler fire;Some coal I found that was lying around, and I heaped the fuel higher;The flames just soared, and the furnace roared — such a blaze you seldom see;And I burrowed a hole in the glowing coal, and I stuffed in Sam McGee.

Then I made a hike, for I didn't like to hear him sizzle so;And the heavens scowled, and the huskies howled, and the wind began to blow.It was icy cold, but the hot sweat rolled down my cheeks, and I don't know why;And the greasy smoke in an inky cloak went streaking down the sky.

I do not know how long in the snow I wrestled with grisly fear;But the stars came out and they danced about ere again I ventured near;I was sick with dread, but I bravely said: "I'll just take a peep inside.I guess he's cooked, and it's time I looked"; ... then the door I opened wide.

And there sat Sam, looking cool and calm, in the heart of the furnace roar;And he wore a smile you could see a mile, and said: "Please close that door.It's fine in here, but I greatly fear, you'll let in the cold and storm —Since I left Plumtree, down in Tennessee, it's the first time I've been warm."

There are strange things done in the midnight sun By the men who moil for gold;The Arctic trails have their secret talesThat would make your blood run cold;The Northern Lights have seen queer sights,But the queerest they ever did seeWas that night on the marge of Lake LebargeI cremated Sam McGee.

Today we went whitewater rafting. Our guide, I swear, was a guy named Stoner.

Craig, of course, was horrified at the idea he might get wet, and so insisted on sitting in the middle of the raft. Frank and Marie loved the idea of getting soaked, and even wanted to help row. So Stoner gave them each a paddle.

For a while they were somewhat helpful, and it kept them busy. Until we hit a stretch of non-rowing quiet water.

Somehow a shouting match broke out, and I turned around just in time to see them beating each other WITH THE PADDLES while Craig tried to hide in the bottom of the raft. Before I could yell at them to stop, Frank sent Marie’s paddle into the river. Craig, trying to avenge his sister, stood up and knocked Frank’s into the river.

And now we were heading into white water, with half our paddles gone. Stoner was clearly horrified to be watching his company’s property floating behind us, and began frantically steering the boat to try to get them, while Mrs. Grumpy and I paddled away. The next few seconds sent some big waves crashing over the raft, drenching everyone (including Craig). He began hitting Marie on the grounds that it was her fault he was wet, since she’d lost her paddle.

Fortunately, we were able to collect the paddles at the other end of the rapid run. But we spent the rest of the day hearing from Craig about how this was “the worst day ever” because he got wet. All the kids, when we got back to shore, agreed that they liked the river rides at amusement parks better. Wimps.

On the way home we stopped for burgers.

In most of the U.S. condiments are fairly simple: ketchup (yes, I know the Filipino’s like ketchup made from bananas, but I’m talking about the tomato kind), mustard, mayo, BBQ sauce, sometimes 1000 Island dressing. Preferences vary by person and region, but those are the basics

EXCEPT in Utah (and southern Idaho). In this area the main condiment is a concoction called Fry Sauce.

What is Fry Sauce you ask? Nobody really knows, because it’s wildly variable depending on where you eat. Each restaurant/roadstand/house has their own peculiar recipe for it.

But here’s the basic idea: imagine a bunch of typical condiments (ketchup, mayo, mustard, BBQ sauce, 1000 Island, relish, chopped onions, chopped pickles, Russian dressing, Ranch dressing, etc.), all on a shelf. Basically, Fry Sauce is a random combination of any number of these, and it’s usually a pink-red color. To make it I think they take a guy, blindfold him, spin him around 3 times, then send him into the pantry. The first 3 bottles he picks up are what's go into that day’s Fry Sauce. As a result, when you get Fry Sauce, you have no idea what it’s going to taste like.

This evening the planned dinner was turkey & spinach burgers. This didn’t sound good to me to begin with. Then we discovered that the turkey meat had been forgotten. And by the time this was noticed, the town’s grocery store was closed.

So my SIL tried to improvise. She chopped up the spinach, and tried to get it to form patties by mixing it with egg whites, then grilling them.

This was a remarkable unsuccessful endeavor. Frank was convinced that we were either going to starve to death or be forced to eat bugs to survive. I was trying to convince them that they'd love to have hamburger buns with leftover Fry Sauce on them.

Then Mrs. Grumpy saved the day. She went out to the car, and brought in the Costco bag of pancake mix. This was a MUCH more popular item, and we had syrup and butter leftover from breakfast. After a dinner of pancakes everyone was happy, and thanked her for saving our lives. Except for the SIL left with a tray of untouched grilled spinach patties. Who was pissed. She forced her husband and kids to eat her horrible offering (though didn't touch them herself), and ignored the rest of the family who was eating pancakes.

We caught her trying to sneak out of the kitchen later, with a leftover pancake in her purse.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

Singing Foo!

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